Late introduction of complementary feeding, rather than duration of breastfeeding, may protect against adult overweight

Early Infant Feeding Practices and Associations with Growth in Childhood

Early infant growth trajectories have been linked to obesity risk. The aim of this study was to examine early infant feeding practices in association with anthropometric measures and risk of overweight/obesity in childhood. A total of 2492 children from Upstate KIDS, a population-based longitudinal cohort, were included for the analysis. Parents reported breastfeeding and complementary food introduction from 4 to 12 months on questionnaires. Weight and height were reported at 2-3 years of age and during later follow-up at 7-9 years of age. Age and sex z-scores were calculated. Linear mixed models were conducted, adjusting for maternal and child sociodemographic factors. Approximately 54% of infants were formula-fed at <5 months of age. Compared to those formula-fed, BMI- (adjusted B, -0.23; 95% CI: -0.42, -0.05) and weight-for-age z-scores (adjusted B, -0.16; -0.28, -0.03) were lower for those exclusively breastfed. Infants breastfed for ≥12 months had a lower risk of being overweight (aRR, 0.33; 0.18, 0.59) at 2-3 years, relative to formula-fed infants. Compared to introduction at <5 months, the introduction of fruits and vegetables between 5 and 8 months was associated with lower risk of obesity at 7-9 years (aRR, 0.45; 0.22, 0.93). The type and duration of breastfeeding and delayed introduction of certain complementary foods was associated with lower childhood BMI.

Feeding practice during infancy is associated with attention-deficit/hyperactivity disorder and autism spectrum disorder: a population-based study in South Korea

Attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are representative neurodevelopmental disorders. Using a nationwide database, we aimed to investigate whether feeding practices in infancy (breastfeeding and the timing of supplementary food introduction) could impact ADHD or ASD development. We evaluated 1,173,448 children aged 4-6 months who were included in the National Screening Program for Infants and Children (NHSPIC) between 2008 and 2014. We observed individuals until 6-7 years of age. Data on feeding type (milk feeding: exclusive breastfeeding [EBF], partial breastfeeding [PBF], exclusive formula feeding [EFF] at 4-6 months of age; supplementary food introduction: < 6 or > 6 months of age) were obtained from the NHSPIC, and diagnoses were based on the International Classification of Diseases, Tenth Revision. In a generalized linear model, children who received EBF had significantly lower incidence of both ADHD (odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.72-0.82) and ASD (OR: 0.64, 95% CI: 0.60-0.67) than that of children who received EFF. PBF also had a significant protective effect on both ADHD (0.91; 0.85-0.98), and ASD (0.89; 0.83-0.95). The timing of supplementary food introduction was not associated with either ADHD or ASD, although there was an increased risk of ASD in the EFF infants who had supplementary food introduced at > 6 months of age.  Conclusion: Our study strengthens and supports the beneficial effect of breastfeeding on neurodevelopmental disorders in children. Breastfeeding should be encouraged and recommended to promote desirable neurodevelopmental outcomes. What is Known: • Breastfeeding is beneficial for the overall health of children, including neurodevelopmental outcomes and cognitive functions. What is New: • Breastfeeding, especially exclusive breastfeeding, was protective against neurodevelopmental disorders. • The effect of the timing of supplementary food introduction was limited.

Maternal Pre-Pregnancy BMI, Offspring Adiposity in Late Childhood, and Age of Weaning: A Causal Mediation Analysis

Infant feeding practices have been hypothesized to influence offspring's body mass index (BMI) later in life, and women with overweight or obesity tend to wean their infants earlier than women with healthy BMI. We, therefore, aimed to investigate how much early age of weaning mediated the maternal-offspring adiposity relationship. The study included 4920 mother-child pairs from the Avon Longitudinal Study of Parents and Children birth cohort. G-computation was applied to estimate the natural direct (NDE) and indirect (NIE) effects, via the age of weaning (<3 months, 3 months, >3 months), of maternal pre-pregnancy overweight or obesity on offspring's BMI and fat mass index. The NDE of maternal overweight or obesity on offspring BMI at 17 years old was 2.63 kg/m² (95% CI: 2.27 to 2.99). The NIE via the age of weaning was 0.02 kg/m² (95% CI: 0.00 to 0.04), corresponding to 0.8% of the total effect. Similar results were observed for the offspring's fat mass index. The NDE and NIE were similar to the main analyses when we looked at the relationship stratified by breastfeeding status. Our study found a minimal influence of age of weaning on the pathway between maternal and offspring adiposity, indicating the age of weaning may not be a key mediator.

The Infant Diet Quality Index Predicts Dietary and Adiposity Outcomes in US Children 2 to 4 years old

BACKGROUND

Healthy nutrition during the first year of life is critical for optimal growth and development. Limited techniques are available to assess diet quality in infancy, and few have been shown to be predictive of dietary and adiposity outcomes in low-income children.

OBJECTIVE

The objectives of this study were to construct an Infant Diet Quality Index (IDQI) to assess the diet quality from birth to 12 mo and to determine whether the IDQI exhibits predictive validity by estimating the longitudinal associations of IDQI scores with diet quality and weight status at 2 to 4 y.

DESIGN

Data were analyzed from the longitudinal Women, Infants, and Children Infant and Toddler Feeding Practices Study-2 (unweighted, n = 2858; weighted. N = 392,439) using one 24-h dietary recall and survey responses during infancy. The newly constructed IDQI consists of 16 equally-weighted components: 1) breastfeeding duration; 2) exclusive breastfeeding; age of first introduction of: 3) solids, 4) iron-rich cereals, 5) cow milk, 6) sugar-sweetened beverages, 7) salty/sweet snacks, 8) other drinks/liquids, and 9) textured foods; frequency of consuming 10) fruit or 11) vegetables; frequency of consuming different 12) fruit or 13) vegetables; 14) nonrecommended bottle-feeding practices; 15) use of commercial baby foods; and 16) number of meals and snacks. Regression analysis was used to estimate associations between the total IDQI score (range, 0-1) and Healthy Eating Index-2015 (HEI-2015) scores and body mass index z-scores (BMIz) at 2 to 4 y of age, adjusted for covariates (e.g., child age, sex and race/ethnicity; maternal education level, etc.) RESULTS: The total IDQI score was positively associated with HEI-2015 at the age of 2 y (β = 16.7; 95% CI: 12.6, 20.9; P < 0.001), 3 y (β = 14.5; 95% CI: 8.1, 21.0; P < 0.001), and 4 y (β = 15.4; 95% CI: 8.4, 22.4; P < 0.001); and negatively associated with BMIz at the age of 2 y (β = -1.24; 95% CI: -2.01, -0.47; P = 0.002) and 4 y (β = -0.92; 95% CI: -1.53, -0.30; P = 0.003).

CONCLUSIONS

The IDQI has predictive validity for diet quality and weight status in low-income US children.

Why do parents use packaged infant foods when starting complementary feeding? Findings from phase one of a longitudinal qualitative study

BACKGROUND

The first 1000 days in a child's life, from conception to age two, are a critical period for establishing a child's health and development. One important element is the diet that children receive during this time. Dietary intake of infants in the UK has been shown to be high in sugar and salt, with overall energy intakes exceeding recommendations by the time they are two years of age. Commercial infant food, which forms approximately 40-60% of infants' dietary intake, was identified in 2011 as the main contributor to sugar intake for infants aged 4-9 months in the United Kingdom. Further, evidence demonstrates inconsistencies between national recommendations on infant feeding and some of these products in terms of the type available, their nutritional value and product labelling and marketing. Given their role in infants' diets, it is important to understand parental perceptions of these products and why they are chosen.

METHODS

The study comprised the first phase of an in-depth, longitudinal qualitative study which explored parents' experiences of introducing solid foods to their infants over the first year of feeding. 62 parents/ carers were recruited to this phase when their infants were four-six months old. Data collection involved semi-structured interviews and a photo-elicitation exercise. Data from interview transcripts which focused on the purchase and use of packaged purees and commercial snacks were analysed thematically.

RESULTS

Parents/ carers drew on a range of reasons for buying both packaged purees and commercial snacks for their infants. These included anxiety over food preparation, food safety, convenience, cost effectiveness, the pull of brand eco-systems for packaged purees, and the way in which commercial snacks provide opportunities for safe development of motor skills, keep infants occupied, and allow them to take part in family rituals.

CONCLUSION

In considering the use of packaged products as a food source for infants in public health nutrition policy, it is important to understand the broad range of factors that shape parents decisions ranging from the way that products are advertised and perceived, to the non-nutritive roles that they play.

Infant age at egg introduction and malnutrition‐related child growth in the United States

To evaluate the relationship between infant age of egg introduction and malnutrition‐related growth outcomes in the United States, we analysed secondary data of 1716 mother–child dyads in the Infant Feeding Practices Study II and its Year 6 Follow‐Up Study. Malnutrition‐related growth outcomes included body mass index z‐score (BMIZ), obesity (weight‐for‐height z‐score [WHZ] ≥3 or BMIZ ≥ 2), WHZ, wasting (WHZ < −2), height‐for‐age z‐score (HAZ), and stunting (HAZ < –2). Infant age at egg introduction was analysed as a continuous variable. We used generalised estimating equations to estimate the mean difference in continuous outcomes and relative risk [RR]) for binary outcomes, adjusting for related maternal and child confounders. We also explored interactions with child sex, maternal race/ethnicity, maternal educational level, ever breastfeeding, and formula feeding. In the total sample, a later infant age at egg introduction was associated with a lower mean difference in HAZ (confounder‐adjusted mean difference = −0.08, 95% confidence interval [CI]: −0.12 to −0.03 per month) and a higher risk of stunting (confounder‐adjusted RR = 1.17, 95% CI: 1.03–1.33 per month) at 6 years. The associations between infant age at egg introduction and 12‐month growth outcomes differed by child sex. Among females but not among males, later introduction of eggs was associated with a lower mean WHZ (−0.06 [−0.12 to 0.00] per month) at 12 months. Later egg introduction during infancy was associated with a lower mean HAZ and a higher risk of stunting in 6‐year‐old children. Besides this, it was associated with a lower WHZ among females at 12 months.

This secondary data analysis evaluated the relationship between infant age at egg introduction and malnutrition‐related growth outcomes among young US children within the Infant Feeding Practices Study II and its Year 6 Follow‐up Study.

In the total sample, a later infant age at egg introduction was associated with a lower mean 6‐year height‐for‐age z‐score and a higher risk of stunting at 6 years.

The associations between infant age at egg introduction and 12‐month growth outcomes differed by child sex. Later introduction of eggs was associated with a lower mean weight‐for‐height z‐score among females. However, this association was not observed among males.

Comparison of the key modifiable factors in the first 1000 days predicting subsequent overweight and obesity in pre-school children in Tehran: a case-control study

The identification of paediatric obesity predictors in the early stages of life is warranted, as it can influence the development of effective strategies to prevent metabolic disorders. In this case-control study, we assessed nine risk factors for paediatric obesity, namely a birth weight > 4000 g, an exclusive breast-feeding period < 4 months, the introduction of solid food at < 4 months, maternal overweight or obesity before pregnancy, maternal smoking during pregnancy, the presence of gestational diabetes, paternal overweight and obesity and paternal smoking. In order to identify the most relevant predictors of paediatric obesity, we employed a multiple logistic regression model with R2 Cox Snell by adjusting confounders. In the randomly selected 509 preschool children from Tehran, children exposed to gestational diabetes had the maximum predicted probability of obesity (4·36 (1·94, 9·80) %) among the analysed risk factors %. The introduction of solid food at < 4 months of age increased the risk of obesity by 2·98 (1·77, 4·97 %). The OR of childhood obesity was associated with maternal overweight and obesity (2·72(1·60-4·60) %), maternal smoking (2·21 (1·18, 4·11) %) and excessive gestational weight gain (1·89 (1·23, 2·91) %). Paternal smoking and high birth weight increased the risk of paediatrics obesity > 1·8 times (1·15-2·94) and > 1·5 times (1·015-2·43), respectively. There was no association between the paternal BMI, the exclusive breast-feeding time and the risk of paediatric obesity. Among early risk factors, probably gestational diabetes can be considered as the most important predictor for the risk of paediatric obesity.

Early Life Nutrition and the Role of Complementary Feeding on Later Adherence to the Mediterranean Diet in Children up to 3 Years of Age

The first years of life represent a window of opportunity to establish proper dietary patterns and to maintain them over time. Our aim was to describe the diet of a cohort of Spanish children, from 2 to 36 months, and to identify the components that could influence the quality of the diet at 24 and 36 months of age. This was a longitudinal prospective study analyzing information from administered questionnaires about general characteristics and food frequency consumption in 97 full-term babies. At 2–3 months of age, only 53.6% of infants were observed to be breastfed. The intake of animal foodstuffs from 12 to 36 months was higher than national recommendations, and the contrary was true for fruits and vegetables. The intake of vitamin D was below European Food Safety Authority recommendations. Moreover, energy intake at 6 months was inversely associated with Mediterranean Diet Score (MDS) at 24 months, whereas vegetables intake was positively associated with MDS at 36 months. These results could be useful in the creation of future guidelines focused on the promotion of breastfeeding and healthy early-life food habits.

Timing and types of fluids and foods first introduced in a representative sample of toddlers attending day care programs across Lebanon: Are parents following international recommendations?

BACKGROUND

Current WHO's recommendation for optimal infant feeding advises exclusive breastfeeding for 6 months. After this initial period, infants should receive nutritionally adequate and safe complementary food starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond.

PURPOSE

This study examined the timing and types of fluids and foods first introduced in a representative sample of toddlers (n = 1051) from 79 daycares across Lebanon. Questionnaires were self-administered to parents of toddlers (12-36 months) with a participation rate of 67%.

RESULTS

Results showed that more than half of toddlers (55.7%) were introduced to infant formula within their first month of life. Around two-thirds received water as the first type of additional fluid (62.5%) with a mean age of 3.86 ± 2.15 months and fruits or cooked vegetables (69.7%) as the first types of food introduced with a mean age of 5.73 ± 1.56 months. Unfortunately, two-third (67.3%) were not breastfed after solid food introduction.

PRACTICE IMPLICATIONS

Our data on current suboptimal feeding practices in Lebanon shows the need to reinforce BF and CF practices recommendations and guidelines at the community, social and health system levels.

CONCLUSIONS

In the absence of specific recommendations and with the poor involvement of the various stakeholders, it was noted that more than half of the parents were not following the WHO recommendation concerning unnecessary fluid supplementation of infants and were introducing food before the recommended age of 6 months; moreover, only a minority of mothers continued breastfeeding after introducing food to their infants.

The Role of Pediatric Nutrition as a Modifiable Risk Factor for Precocious Puberty

Puberty is a critical phase of growth and development characterized by a complex process regulated by the neuroendocrine system. Precocious puberty (PP) is defined as the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal. The timing of puberty has important public health, clinical, and social implications. In fact, it is crucial in psychological and physical development and can impact future health. Nutritional status is considered as one of the most important factors modulating pubertal development. This narrative review presents an overview on the role of nutritional factors as determinants of the timing of sexual maturation, focusing on early-life and childhood nutrition. As reported, breast milk seems to have an important protective role against early puberty onset, mainly due to its positive influence on infant growth rate and childhood overweight prevention. The energy imbalance, macro/micronutrient food content, and dietary patterns may modulate the premature activation of the hypothalamic-pituitary-gonadal axis, inducing precocious activation of puberty. An increase in knowledge on the mechanism whereby nutrients may influence puberty will be useful in providing adequate nutritional recommendations to prevent PP and related complications.

Complementary Feeding and Growth in Infants Born Preterm: A 12 Months Follow-Up Study

Evidences demonstrated that timing of weaning influences long-term growth in full term infants. However, studies on preterm infants are still lacking, and the international guidelines are focused only on healthy full-term newborn, without consensus for preterms. We aimed at evaluating, in a cohort study, the consequences of different timing of weaning on auxological outcomes up to 12 months of corrected age in a population of neonates born with gestational age < 32 weeks or birth weight < 1500 g. We divided the enrolled neonates in two cohorts according to the timing of weaning: (i) Early Weaning: introduction of complementary food before 6 months of corrected age; (ii) Late Weaning: complementary food introduced after 6 months of corrected age. Growth parameters (weight, length, body mass index, and ponderal index) were measured at 12 months of life. The two groups were statistically comparable for baseline clinical characteristics, and differences on growth parameters were not reported between the two study groups. These results were confirmed in linear and binary logistic regression multivariate models. Timing of weaning is not related to growth of preterm newborns in the first 12 months of corrected age. Studies are needed to reach consensus for the appropriate nutritional approach for preterm babies after discharge.

Association of infant feeding patterns with body fat mass and obesity in the first 2 years of life: a longitudinal twin birth cohort study

Childhood obesity is a major public health problem with no effective intervention. We explored the influence of feeding patterns on infants' growth indices within the first 2 years in a twin birth cohort. Dietary intake at 12 months was recorded with a food frequency questionnaire, and dietary patterns were identified by principal component analysis. Milk feeding methods in first 6 months were categorised as breastfeeding or exclusive formula feeding. Correlations between feeding patterns and infants' growth indices were examined via generalised estimating equations. Two dietary patterns were identified and neither of which was related to growth indices. Breastfed infants had a higher body fat mass (BFM) percentage at 12 months, a higher body mass index (BMI) increment from birth to 6 months and a lower BMI increment from 6 to 12 months. Breastfed infants were likely positively correlated with BFM at 12 months; as complementary food was added, the effect of breastfeeding on growth gradually decreased.

Infant Feeding and Ethnic Differences in Body Mass Index during Childhood: A Prospective Study

This study investigated ethnic differences in childhood body mass index (BMI) in children from Dutch and Turkish descent and the role of infant feeding factors (breastfeeding duration, milk feeding frequency, as well as the timing, frequency and variety of complementary feeding (CF)). We used data from 244 children (116 Dutch and 128 Turkish) participating in a prospective study in the Netherlands. BMI was measured at 2, 3 and 5 years and standard deviation scores (sds) were derived using WHO references. Using linear mixed regression analyses, we examined ethnic differences in BMI-sds between 2 and 5 years, and the role of infant feeding in separate models including milk or CF factors, or both (full model). Relative to Dutch children, Turkish children had higher BMI-sds at age 3 (mean difference: 0.26; 95%CI: 0.04, 0.48) and 5 (0.63; 0.39, 0.88), but not at 2 years (0.08; -0.16, 0.31). Ethnic differences in BMI-sds were somewhat attenuated by CF factors at age 3 (0.16; -0.07, 0.40) and 5 years (0.50; 0.24, 0.77), whereas milk feeding had a minor impact. Of all factors, only CF variety was associated with BMI-sds in the full model. CF factors, particularly CF variety, explain a small fraction of the BMI-sds differences between Dutch and Turkish children. The role of CF variety on childhood BMI requires further investigation.

Identification of Nutritional Targets in Spanish Children Belonging to the LAyDI Cohort for the Development of Health Promotion Strategies in the First Two Years of Life

The first 1000 days of life seem to represent the temporal window of opportunity for modulating some of the risk factors associated with the later development of pathologies. Nonetheless, the dietary pattern and nutritional status of children receiving complementary feeding is still understudied. We aimed to assess the food intake in children from the LAyDI cohort (Spain) at 18 and 24 months of age and evaluate this in relation to nutrient requirements and bioactive compound consumption. This was a prospective and multicenter study analyzing information from administered questionnaires about general characteristics and food frequency consumption in 426 children of 18 months and 336 of 24 months. The observed intake of vegetables, fruits, dairy, and eggs was lower than the recommendations in both periods, contrary to the consumption of meat, fish, and pulses. The consumption of energy and macronutrients was similar for all ages studied, with protein intake being slightly higher than the recommended values. Regarding micronutrients, practically the whole sample fell below the vitamin D requirements. In addition, the estimated daily intakes of vitamin E and iron, at 24 months, were below the recommended values for this population group. The mean intake of phenols was around 650 mg/day. Flavanol intake as well as both types of fiber decreased from 18 to 24 months. In conclusion, although these results have to be confirmed in other populations, it seems pertinent to propose the design of nutritional strategies aimed at increasing the intake of vitamins D and E as well as iron in Spanish children up to 2 years.

Feeding patterns and BMI trajectories during infancy: a multi-ethnic, prospective birth cohort

BACKGROUND

Milk feeding type (exclusive breastfeeding [EBF], formula feeding or mixed feeding) and timing of complementary feeding (CF) have been associated with infant growth. However, studies evaluating their combined role, and the role of ethnicity, are scarce. We examined associations of feeding patterns (milk feeding type combined with timing of CF) with infant body mass index (BMI) trajectories and potential ethnic-specific associations.

METHODS

Infant feeding and BMI data during the 1st year of life from 3524 children (Dutch n = 2880, Moroccan n = 404 and Turkish n = 240) from the Amsterdam Born Children and their Development (ABCD) cohort were used. Six feeding patterns were defined: EBF/earlyCF, EBF/lateCF (reference), formula/earlyCF, formula/lateCF, mixed/earlyCF and mixed/lateCF. A covariate adjusted latent class mixed model was applied to simultaneously model BMI trajectories and associations with feeding patterns. Potential ethnic differences in the associations were studied in a separate model where interactions between ethnicity and feeding patterns were included.

RESULTS

Four distinct BMI trajectories (low, mid-low, mid-high and high) were identified. Feeding pattern of formula/earlyCF was associated with lower odds for low (OR: 0.43; 95% CI: 0.25, 0.76) or mid-high (0.28; 0.16, 0.51) (ref: high) trajectory compared with EBF/lateCF pattern (ref). An ethnic-specific model revealed that among Dutch infants, formula/earlyCF pattern was associated with lower odds for low trajectory (0.46; 0.24, 0.87), whereas among Turkish/Moroccan infants almost all feeding patterns were associated with lower odds for the low trajectory (ref: high).

CONCLUSION

Infant feeding patterns are associated with early BMI trajectories with specific ethnic differences. Future studies should take the role of ethnicity into account in the associations between infant feeding and growth.

Complementary feeding practices and their association with adiposity indicators at 12 months of age

Nutrition during the first 1000 days of life represents a window of opportunity to reduce the risk of metabolic dysfunctions later in life. Exclusive breastfeeding (EBF) and adequate introduction of solid foods are essential to promote metabolic and nutritional benefits. We evaluated the association of infant feeding practices from birth to 6 months (M) with adiposity indicators at 12 M. We performed a secondary analysis of 106 healthy term infants born from a cohort of healthy pregnant women. Type of breastfeeding (exclusive or nonexclusive), the start of complementary feeding (CF) (before (<4 M) or after (≥4 M)), and adiposity (body mass index - BMI, body mass index-for-age - BMI/A, waist circumference - WC, and waist circumference-length ratio - WLR) were evaluated at 12 M using descriptive statistics, mean differences, X2, and linear regression models. During the first 6 M, 28.3% (n = 30) of the infants received EBF. Early CF (<4 M) was present in 26.4% (n = 28) of the infants. Children who started CF < 4 M were less breastfed, received added sugars as the most frequently introduced food category, and showed higher BMI, BMI/A, WC, and WLR; those who consumed added sugars early (<4 M) had a higher WC. Starting CF < 4 M was the main factor associated with a higher WC at 12 M. Unhealthy infant feeding practices, such as lack of EBF, early CF, and early introduction of sugars, may be associated with higher adiposity at 12 M.

Maternal psychological distress and child weight at 24 months: investigating indirect effects through breastfeeding in the All Our Families cohort

OBJECTIVE

Maternal psychological distress in pregnancy has been associated with both breastfeeding duration and child weight at 24 months; however, the potential that breastfeeding duration partially mediates the risk of maternal mental health problems during pregnancy on child weight classification has not been examined. The current study investigated this proposed relationship.

METHODS

Data was taken from the All Our Families (AOF) cohort, an ongoing prospective pregnancy cohort located in Calgary, Canada. Psychological distress, defined as clinically significant symptoms of anxiety and depression, was assessed via self-report and measured between 34 and 36 weeks of gestation. Breastfeeding duration was assessed in the postpartum by self-report. Child overweight classification was defined as a weight-for-length/height z-score at or above the 97th percentile as per World Health Organization's child growth guidelines.

RESULTS

In this sample of 1582 mother-child pairs, there was no direct relationship between psychological distress and child overweight status. Both anxiety (B = - 5.40, p = 0.001) and depression (B = - 6.54, p = 0.008) were associated with decreased weeks breastfeeding. Breastfeeding duration mediated the association between maternal prenatal psychological distress and child overweight status at 24 months, for both anxiety (B(SE) = 0.10(0.05), CI 0.03-0.21) and depression (B(SE) = 0.11(0.07), CI 0.01-0.27). Covariates included maternal age, education, ethnicity, income, pre-pregnancy BMI, gestational weight gain, and infant birth weight.

CONCLUSIONS

The results of this longitudinal cohort analysis support an indirect relationship between maternal psychological distress in pregnancy and the childhood overweight/obesity at 24 months old, mediated through breastfeeding duration.

Possible Modifiers of the Association Between Change in Weight Status From Child Through Adult Ages and Later Risk of Type 2 Diabetes

OBJECTIVE

We investigated the association between changes in weight status from childhood through adulthood and subsequent type 2 diabetes risks and whether educational attainment, smoking, and leisure time physical activity (LTPA) modify this association.

RESEARCH DESIGN AND METHODS

Using data from 10 Danish and Finnish cohorts including 25,283 individuals, childhood BMI at 7 and 12 years was categorized as normal or high using age- and sex-specific cutoffs (<85th or ≥85th percentile). Adult BMI (20-71 years) was categorized as nonobese or obese (<30.0 or ≥30.0 kg/m², respectively). Associations between BMI patterns and type 2 diabetes (989 women and 1,370 men) were analyzed using Cox proportional hazards regressions and meta-analysis techniques.

RESULTS

Compared with individuals with a normal BMI at 7 years and without adult obesity, those with a high BMI at 7 years and adult obesity had higher type 2 diabetes risks (hazard ratio [HR]_girls 5.04 [95% CI 3.92-6.48]; HR_boys 3.78 [95% CI 2.68-5.33]). Individuals with a high BMI at 7 years but without adult obesity did not have a higher risk (HR_girls 0.74 [95% CI 0.52-1.06]; HR_boys 0.93 [95% CI 0.65-1.33]). Education, smoking, and LTPA were associated with diabetes risks but did not modify or confound the associations with BMI changes. Results for 12 years of age were similar.

CONCLUSIONS

A high BMI in childhood was associated with higher type 2 diabetes risks only if individuals also had obesity in adulthood. These associations were not influenced by educational and lifestyle factors, indicating that BMI is similarly related to the risk across all levels of these factors.

Changes and correlations in height from 7 to 69 years of age across the birth years of 1930 to 1989

OBJECTIVES

The aims of this study were to describe changes in height during childhood and to investigate potential changes in the proportion of children attaining final height in childhood and in correlations between child and adult height across birth cohorts.

METHODS

We included 363 059 children (179 906 girls) from the Copenhagen School Health Records Register, who were born between 1930 and 1989, with height measurements at ages 7, 10, or 13 years. Linkages to data resources containing adult height values between ages 18 and 69 years were possible for a subpopulation of 96 133 individuals (23 051 women). Birth years were categorized as 1930 to 1939, 1940 to 1949, and 1950 to 1989. Descriptive height statistics were estimated by birth years and birth cohorts. Height correlations were examined using sex- and age-specific partial Pearson correlation analyses and meta-regression techniques.

RESULTS

Across 60 birth years, mean child heights at age 7 increased by 2.9 cm in girls and 3.0 cm in boys, and adult heights increased as well. The proportions of children attaining final height by age 13 remained low across the birth cohorts; nonetheless, there was a significant increase from 0.7% to 1.5% in girls only (P < .0001). Both child-child and child-adult height correlations were strong and remained relatively stable across birth cohorts.

CONCLUSIONS

Mean child and adult height increased during the study period, but the proportion of children attaining final height at age 13 remained low. Child-child and child-adult height correlations were largely unchanged across birth cohorts.

Timing of Complementary Feeding Introduction and Adiposity Throughout Childhood

OBJECTIVES

To examine associations of the timing of complementary feeding (CF) introduction with adiposity throughout childhood.

METHODS

We studied 1013 children from Project Viva. Our exposure was CF introduction, categorized as <4 months (19%), 4 to <6 months (68%; reference group), and ≥6 months of age (14%). Our outcomes included adiposity measures in midchildhood (mean: 7.9 years; SD 0.8; n = 896) and early adolescence (mean: 13.2 years; SD 0.9; n = 850). We used linear regression models adjusted for potential confounders and ran separate models for infants who were breastfed at least partly for ≥4 months (categorized as breastfed; 69%) and infants who were never breastfed or stopped breastfeeding at <4 months (categorized as formula fed; 31%).

RESULTS

CF initiated at <4 months was associated with higher adiposity in midchildhood in breastfed children; associations persisted into adolescence for waist circumference, truncal fat mass, and the sum of subscapular and triceps skinfolds (eg, waist circumference: confounder-adjusted β 2.97 [95% confidence interval (CI) 0.47 to 5.47] cm). The effect estimates were larger in formula-fed children, with more associations persisting into adolescence (eg, waist circumference: adjusted β 3.42 [95% CI 0.12 to 6.71] cm). CF initiated at ≥6 months was associated with a higher subscapular/triceps skinfold ratio in midchildhood and adolescence (adjusted β 0.13 [95% CI 0.02 to 0.25]) in formula-fed children.

CONCLUSIONS

We found associations of early CF introduction with higher adiposity measurements in breastfed and formula-fed children and associations of late introduction of CF with higher adiposity in formula-fed children.

Infants' transition from milk to solid foods - the lived experiences of first-time parents

Purpose: During the transition from ingesting milk to ingesting solid food, infants substantiate their eating habits. The present study focuses on this transition. Specifically, it aimed to explore first-time parents’ lived experiences of their infants’ transition from milk to solid foods.

Method: The study is based on the descriptive phenomenological approach Reflective Lifeworld Research (RLR). Ten mothers and ten fathers were interviewed twice; when the infants were aged four to five months and again at seven to eight months of age. Data were analysed according to RLR principles.

Results: The findings show that the transition from milk to solid food is a demanding in-between phase. The physically intimate feeding situation is replaced by unfamiliar situations in which parents and infant are physically separated and new types of food are introduced. The process of feeding requires parents’ full attention and sensitivity towards the infant’s reactions.

Conclusion: The study highlights how shared parental experiences were reflected in frames for how a meal should normally proceed, including parents’ desire to create healthy eating habits and uphold harmony duringfamily meals

We suggest for health professionals to present parents with a wider frame of normality, especially as concerns the concept of what constitutes “normal” eating patterns.

Complementary feeding: new styles versus old myths

Early life feeding habits may potentially alter future metabolic programming and body composition. Complementary feeding is the period of time when infants introduce food different from milk in their diet, together with a gradual reduction of the intake of milk (either breast milk or formula), to finally acquire the diet model of their family. This period is important in the transition of the infant from milk feeding to family foods, and is necessary for both nutritional and developmental reasons. The timing for introducing complementary foods and the method of feeding have changed over time. Available literature data show increasing interest and concerns about the impact of complementary feeding timing and modality on the onset of later non-communicable disorders, such as overweight and obesity, allergic diseases, celiac disease, or diabetes. While international scientific guidelines on complementary feeding have been published, many baby food companies' websites, blogs, and books, in most European countries exist. The aim of this manuscript is to look over current recommendations, and to revise "old myths." The adoption of an adequate weaning method is a cornerstone in the development of life-long health status. A correct strategy could reduce the risk of feeding disorders and other health problems later in life.

Appropriate age range for introduction of complementary feeding into an infant's diet

Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.

Breastfeeding duration in infancy and adult risks of type 2 diabetes in a high-income country

Observed associations between breastfeeding and reduced risk of type 2 diabetes in adulthood may be confounded. We examined if the duration of breastfeeding in infancy was associated with the risk of type 2 diabetes in adulthood after adjustment for a range of prenatal and postnatal risk factors. We prospectively followed 6,044 individuals from the Copenhagen Perinatal Cohort born 1959-1961. Duration of any breastfeeding (≤0.5, >0.5-1, >1-2, >2-4, >4 months) was assessed at the infant's 1-year health examination. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for type 2 diabetes (at age ≥30 years, 237 persons) by breastfeeding duration without and with adjustment for parental social status and education, maternal pre-pregnancy body mass index (BMI), maternal diabetes and smoking during pregnancy, gestational weight gain, parity, preterm birth, birth weight, sex, and BMI at ages 7 and 41-43 years. In the unadjusted analysis, compared with infants breastfed for ≤0.5 month, those breastfed for >4 months had a 51% reduced risk of type 2 diabetes (HR = 0.49; 95% CI [0.32, 0.75]). After the stepwise adjustment for putative early life confounders, this was attenuated to a nonsignificant 31% reduced risk (HR = 0.69; 95% CI [0.44, 1.07]). Adjustment for childhood and adulthood BMI minimally changed the results. We found that the inverse association between the duration of breastfeeding and risk of type 2 diabetes in adulthood is considerably weakened and no longer significant after adjustment for prenatal and postnatal factors in the infant and mother.

Longitudinal Associations between Dietary Patterns and Weight Status in Puerto Rican Infants and Toddlers' Participants of the WIC Program

OBJECTIVE

To explore the associations between feeding practices and diet quality with weight in Puerto Rican infants/toddlers.

METHODS

This was a longitudinal study done in a sample of 296 caregivers and their children aged 0-24 months from a WIC clinic in PR. A. Caregivers completed questionnaires on socio-demographics and feeding practices and infant's weight and length were measured at the baseline and follow-up (1 year later) visits. Diet quality was assessed using an adapted version of the Diet Quality Index Score (DQIS) for infants/toddlers.

RESULTS

A total of 77 participants completed the follow-up visit. At baseline, overweight/obesity was found in 5% while in the follow-up visit it increased to 16%. Exclusive breastfeeding for less than one month (RR 1.32, 95% C.I. 1.10, 1.59) and formula-based diets (RR 1.29; 95% C.I. 1.08, 1.54) increased the odds of overweight/ obesity at follow-up compared to longer breastfeeding and those never formula-fed. DQIS significantly decreased from the baseline to the follow-up visit. The overall DQIS was not significantly associated with weight; however, a trend was observed between a negative change in the breast-milk and 100% juices score with higher odds of overweight/obesity while a negative change in the vegetable score was associated with lower odds of overweight/obesity.

CONCLUSION

Diet quality significantly decreased over time in our sample. Breastfeeding for less than one month and formula-based diets significantly increased the odds of overweight/obesity at follow-up, but no significant associations were found with DQIS or its components.

Age of introduction of complementary feeding and overweight in adolescence and adulthood: A systematic review

Recent studies on early infant feeding suggest that the type of diet and age of starting complementary foods may have a positive correlation with overweight in adolescence and adulthood. This study aimed to systematically review the evidence on the relationship between the age of introduction of complementary feeding and excess weight in adolescence and adulthood (PROSPERO: CRD42017067764). The preferred reporting items for systematic reviews and meta-analyses standards were used as a reference. Articles were researched on Medline via PubMed, Web of Science, Embase, Lilacs, Ovid, and Scopus, between June and December 2017. Descriptors were defined according to Medical Subject Heading. Of the 103 articles selected for complete reading, nine were included in the review. Of these, only three found an association between the age of introduction of complementary feeding and overweight. Despite these findings, the studies presented a high heterogeneity, mainly due to the difference in cut-off points for the age of introduction of complementary feeding and the classification of overweight. We concluded that the evidence was not consistent enough to confirm the existence of the association.

Types and amounts of complementary foods and beverages consumed and growth, size, and body composition: a systematic review

BACKGROUND

Systematic reviews (SRs) were conducted by the Nutrition Evidence Systematic Review (NESR) team for the USDA's and the Department of Health and Human Services' Pregnancy and Birth to 24 Months Project.

OBJECTIVES

The aim was to describe the SRs examining the relationship between types and amounts of complementary foods and beverages (CFBs) and growth, size, and body-composition outcomes.

METHODS

The NESR team collaborated with subject matter experts to conduct this SR. The literature was searched and screened using predetermined criteria. For each included study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of evidence was graded.

RESULTS

This SR includes 49 articles that examined type, amount, or both of CFBs consumed and growth, size, and body-composition outcomes. Moderate evidence suggests that consuming either different amounts of meat, meat instead of iron-fortified cereal, or types of CFBs with different fats or fatty acids does not favorably or unfavorably influence growth, size, or body composition. In relation to overweight/obesity, insufficient evidence is available with regard to the intake of meat or CFBs with different fats or fatty acids. Limited evidence suggests that type and amount of fortified infant cereal does not favorably or unfavorably influence growth, size, body composition, or overweight/obesity. Limited evidence suggests that sugar-sweetened beverage consumption during the complementary feeding period is associated with increased obesity risk in childhood but is not associated with other measures of growth, size, or body composition. Limited evidence showed a positive association between juice intake and infant weight-for-length and child body mass index z scores. Insufficient evidence is available on other CFBs or dietary patterns in relation to outcomes.

CONCLUSIONS

Although several conclusions were drawn, additional research is needed that includes randomized controlled trials, examines a wider range of CFBs, considers issues of reverse causality, and adjusts for potential confounders to address gaps and limitations in the evidence.

Timing of introduction of complementary foods and beverages and growth, size, and body composition: a systematic review

BACKGROUND

The systematic review described in this article was conducted as part of the USDA and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.

OBJECTIVES

The aim was to describe the relationship between timing of introduction of complementary foods and beverages (CFBs) and growth, size, and body-composition outcomes across the life span.

METHODS

The literature was searched and selected using predetermined criteria. Data were extracted and risk of bias assessed for each included study. Evidence was qualitatively synthesized, conclusion statements were developed, and the strength of the evidence was graded.

RESULTS

Eighty-one articles were included in this systematic review that addressed timing of CFB introduction relative to growth, size, and body-composition outcomes from infancy through adulthood. Moderate evidence suggests that introduction of CFBs between the ages of 4 and 5 mo compared with ∼6 mo is not associated with weight status, body composition, body circumferences, weight, or length among generally healthy, full-term infants. Limited evidence suggests that introduction of CFBs before age 4 mo may be associated with higher odds of overweight/obesity. Insufficient evidence exists regarding introduction at age ≥7 mo.

CONCLUSIONS

Although several conclusions were drawn in this systematic review, additional research is needed to address gaps and limitations in the evidence on timing of introduction of CFBs and growth, size, and body composition, such as randomized controlled trials that examine multiple outcomes and/or CFB introduction between the ages of 4 and 6 mo, and research that accounts for potential confounders such as feeding practices and baseline growth status and considers issues of reverse causality.

Infant Complementary Feeding of Prebiotics for theMicrobiome and Immunity

Complementary feeding transitions infants from a milk-based diet to solid foods, providing essential nutrients to the infant and the developing gut microbiome while influencing immune development. Some of the earliest microbial colonisers readily ferment select oligosaccharides, influencing the ongoing establishment of the microbiome. Non-digestible oligosaccharides in prebiotic-supplemented formula and human milk oligosaccharides promote commensal immune-modulating bacteria such as Bifidobacterium, which decrease in abundance during weaning. Incorporating complex, bifidogenic, non-digestible carbohydrates during the transition to solid foods may present an opportunity to feed commensal bacteria and promote balanced concentrations of beneficial short chain fatty acid concentrations and vitamins that support gut barrier maturation and immunity throughout the complementary feeding window.

Diet Quality of US Infants and Toddlers 7-24 Months Old in the WIC Infant and Toddler Feeding Practices Study-2

Background

Despite the important implications of childhood dietary intakes on lifelong eating habits and health, data are lacking on the diet quality of low-income infants and toddlers.

Objective

The objective of this study was to characterize diet quality in low-income US infants and toddlers.

Methods

A national observational study was conducted of 7- to 12-mo-old (n = 1261), 13-mo-old (n = 2515), and 24-mo-old (n = 2179) children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prenatally/at birth from 2013 to 2016. The study used a 24-h dietary recall and survey questions. For 7- to 12-mo-olds, an adapted Complementary Feeding Utility Index (CFUI) was used, and for 13- and 24-mo-olds, the Healthy Eating Index-2015 (HEI-2015) was used. Descriptive statistics were calculated for CFUI and HEI-2015 scores.

Results

For 7- to 12-mo-olds, the CFUI score (mean ± SE) was 0.56 ± 0.003 (range: 0.34-0.90, maximum possible 1.0). Most children met CFUI standards for exposure to iron-rich cereal (86.7%), and low exposure to energy-dense nutrient-poor foods (72.2%) and teas/broths (67.5%). Conversely, at 7-12 mo of age, exposure was low for vegetables (7.0%), fruits (14.4%), any sugary drinks (14.0%), and 12-mo breastfeeding duration (23.8%). At 13 and 24 mo of age, the HEI-2015 total score (maximum possible 100), on average, was 64.0. At both 13 and 24 mo of age, participants achieved, on average, maximal HEI-2015 component scores for total and whole fruits and dairy; however, scores for total vegetables, greens and beans, whole grains, seafood and plant proteins, fatty acids, and saturated fats were relatively low. Scores for refined grains, sodium, and added sugar were lower at 24 than at 13 mo of age, representing higher consumption, on average, over time.

Conclusions

Although findings demonstrate that young children are doing well on some dietary components, there is room for improvement, especially as children age. Findings may be used to inform the Pregnancy and Birth to 24-mo (P/B-24) Project. This trial was registered at clinicaltrials.gov as NCT02031978.

Age at Introduction of Solid Food and Obesity Throughout the Life Course

OBJECTIVE

This study aimed to examine the association between age at solid food (SF) introduction and obesity throughout the life course.

METHODS

Among 31,816 mother- nurse daughter dyads in the Nurses' Mothers' Cohort Study and the Nurses' Health Study II, information was collected on age at SF introduction, body somatotype at ages 5 and 10, and Body Mass Index at age 18 and in adulthood. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for obesity throughout life were estimated using logistic regression models with adjustment for parental and nurse daughter covariates.

RESULTS

Nurse daughters introduced to SF at ≥ 9 months versus 6 to 9 months had marginally higher age-adjusted (OR: 1.21; 95% CI: 1.01, 1.47) and covariate-adjusted (OR: 1.22; 95% CI: 1.01, 1.47) odds of obesity at age 5. Age at SF introduction was not related to obesity at ages 10 and 18 or in adulthood.

CONCLUSIONS

Late age at SF introduction was marginally associated with obesity at age 5, but this association did not persist throughout the life course.

MÉTODO BABY-LED WEANING (BLW) NO CONTEXTO DA ALIMENTAÇÃO COMPLEMENTAR: UMA REVISÃO

Objective:

To review the scientific findings on the baby-led weaning method (BLW) in the context of complementary feeding.

Data sources:

Two independent examiners searched the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed database in August 2016. No time-period was defined for the publication dates. The following descriptors were used: “baby-led weaning” OR “baby-led” OR “BLW”. Inclusion criteria were: original studies that were available in English, and which addressed the BLW method. Exclusion criteria were: references in other languages, opinion articles and literature reviews, editorials and publications that did not elaborate on the intended subject. Of the 97 references identified, 13 were included in the descriptive synthesis.

Data synthesis:

The BLW group of babies, when compared to the traditional eating group, were less prone to being overweight, less demanding of food, and ate the same foods as the family. The number of choking episodes did not differ between groups. Mothers who opted for the implementation of BLW had higher levels of schooling, held managerial positions at work, and were more likely to have breastfed until the sixth month of the child’s life. Concerns were raised about messes made during meals, wasting food, and choking, but most of the mothers recommended adopting the method. Health professionals were hesitant to indicate this method.

Conclusions:

BLW was recommended by mothers who followed the method with their own children. However, concerns have been reported, which, coupled with professionals’ fears about the inability of infants to self-feed, reflect a lack of knowledge about the method.

Duration of Breastfeeding, but Not Timing of Solid Food, Reduces the Risk of Overweight and Obesity in Children Aged 24 to 36 Months: Findings from an Australian Cohort Study

This study aimed to determine whether breastfeeding duration and the timing of solid food were independently associated with being overweight or obese in early childhood. Subjects were 953 children participating in the Study of Mothers and Infants Life Events Affecting Oral Health (SMILE) birth cohort study, based in Adelaide, Australia. Socio-demographic information and data on breastfeeding duration and age of introduction of solid food were collected at birth, 3, 4, 6, 12, and 24 months via mailed or online questionnaires completed by mothers. The weight and height of children were measured at a dental examination when children were aged between 24 and 36 months. Body mass index was calculated, and children were categorised into weight groups according to the World Health Organization growth standards. Multivariable logistic regression analysis was conducted, adjusting for maternal age at birth, education, socio-economic status, pre-pregnancy weight, smoking in pregnancy, method of delivery, and child’s birthweight. Risk of overweight/obesity was independently associated with maternal pre-pregnancy BMI, smoking in pregnancy, and birthweight. Children that were breastfed for 12 months or more had a significantly lower risk of being overweight/obese than those breastfed for less than 17 weeks (AOR 0.49; 95%CI 0.27, 0.90; p for trend =0.009). Age of introduction of solid food, however, was not associated with the risk of being overweight/obese at 24 to 36 months. This study provides further evidence of an inverse relationship between breastfeeding and risk of overweight/obesity, however, no association with the timing of solid food was detected.

Breastfeeding and complementary feeding in relation to body mass index and overweight at ages 7 and 11 y: a path analysis within the Danish National Birth Cohort

Background

Infant feeding may play an important role in the development of childhood overweight and obesity.

Objective

The objective of this study was to examine whether duration of breastfeeding (BF), timing of introduction of complementary food, and protein intake at age 18 mo are associated with body mass index [BMI (measured in kg/m2)] and overweight at ages 7 and 11 y, independent of BMI during infancy.

Design

Children participating in the Danish National Birth Cohort were followed up at ages 7 and 11 y. Information on infant feeding, protein intake at age 18 mo, Ponderal Index at birth, child BMI (at ages 5 mo, 12 mo, 7 y, and 11 y), and several parental factors was available. Path analysis was used to assess the direct and indirect effects of infant feeding on BMI z scores (BMIz) at ages 7 (n = 36,481) and 11 y (n = 22,047). Logistic regression analyses were used to examine associations with overweight.

Results

Duration of BF was not associated with childhood BMIz at ages 7 and 11 y. Earlier introduction of complementary food (<4 mo old) was not associated with BMIz at age 7 y, but with a 0.069 (95% CI: 0.021, 0.117, P = 0.005) higher BMIz at age 11 y and increased risk of overweight at age 11 y (OR 1.44; 95% CI: 1.04, 2.00; P = 0.03). Protein intake from dairy products (per 5 g/d) was associated with higher BMIz only at age 7 y (OR: 0.012; 95% CI: 0.003, 0.021; P = 0.007). Protein intake from meat and fish (per 2 g/d) was associated with a 0.010 (95% CI: 0.004, 0.017; P = 0.003) higher BMIz at age 7 y, a 0.013 (95% CI: 0.005, 0.020; P = 0.002) higher BMIz at age 11 y and increased odds of overweight at age 7 y (OR: 1.07; 95% CI: 1.03, 1.10; P < 0.001), but not at age 11 y.

Conclusions

Intake of protein from meat and fish at age 18 mo was associated with higher BMIz and risk of overweight in childhood. However, the effect sizes were small. Early introduction of complementary food may be associated with child BMIz and child overweight. This study was registered at www.clinicaltrials.gov as NCT03334760.

Feeding Practices and Infant Growth: Quantifying the Effects of Breastfeeding Termination and Complementary Food Introduction on BMI z-Score Growth Velocity through Growth Curve Models

BACKGROUND

Infant feeding practices are a focus of early obesity prevention. We tested whether infant growth velocity increased after breastfeeding termination and complementary food introduction.

METHODS

Our secondary analysis included a sample of 547 mother-infant dyads from a longitudinal randomized controlled trial conducted in Michigan and Colorado. Infant anthropometrics at birth, baseline, and 6- and 12-month follow-up were standardized to BMI-for-age z-score (ZBMI) according to World Health Organization (WHO) growth charts. We used growth curve models with time-varying predictors to quantify effects of breastfeeding termination and timing of complementary food introduction on growth velocity.

RESULTS

Median breastfeeding duration was 2.0 months [confidence interval (CI) = 2.0-2.5]; median introduction of complementary foods occurred at 3.0 months (CI = 2.8-3.2). Breastfed infants not yet introduced to complementary foods had an average ZBMI growth velocity of 0.050 (CI = -0.013 to 0.113) z-score units per month [zpm], not significantly faster than WHO growth trajectory (p = 0.118) defined as 0 zpm. Breastfeeding termination had negligible effect on ZBMI growth velocity (γ₁₁ = 0.001, CI = -0.027 to 0.030, p = 0.927). Introduction of complementary foods increased ZBMI growth velocity relative to an average child in the sample, but not significantly (γ₁₂ = 0.033, CI = -0.034 to 0.100, p = 0.334). Growth velocities for infants receiving complementary foods both before and after breastfeeding termination were significantly faster than the WHO growth trajectory (0.083 zpm, CI = 0.052-0.114, and 0.084 zpm, CI = 0.064-0.105, respectively, p's < 0.001).

CONCLUSIONS

Average postcomplementary food introduction growth velocity was significantly higher than WHO growth trajectory, but did not differ from the sample's initial average trajectory. Growth curve models can accurately estimate effects of feeding practices on infant growth to direct obesity prevention efforts.

Factors associated with the introduction of complementary feeding in the French ELFE cohort study

The objectives of this study were to estimate the age of complementary feeding introduction (CFI) and investigate the related health, demographic, and socio-economic factors. Analyses were based on 10,931 infants from the French national birth cohort ELFE, born in 2011. Health, demographic, and socio-economic data concerning infants and parents were collected at birth (face-to-face interviews and medical records) and 2 months (telephone interviews). Data on milk feeding and CFI practices were collected at birth and 2 months then monthly from 3 to 10 months using online or paper questionnaires. The associations between both health and social factors and CFI age were tested by multivariable multinomial logistic regressions. The mean CFI age was 5.2 ± 1.2 months; 26% of the infants started complementary feeding before 4 months of age (CF < 4 months), 62% between 4 and 6 months of age, and 12% after 6 months of age (CF > 6 months). CF < 4 months was more likely when mothers smoked, were overweight/obese, younger (<29 years), and used their personal experience as an information source in child caregiving and when both parents were not born in France. CF < 4 months was less likely when the infant was a girl, second-born, when the mother breastfed longer, and had attended at least one birth preparation class. Mothers of second-born infants and who breastfed their child longer were more likely to introduce CF > 6 months. Couples in which fathers were born in France and mothers were not born in France were less likely to introduce CF > 6 months. CF < 4 months occurred in more than 25% of the cases. It is important to continue promoting clear CFI recommendations, especially in smoking, overweight, young, not born in France, and nonbreastfeeding mothers.

Influence of infant feeding patterns over the first year of life on growth from birth to 5 years

OBJECTIVES

As early-life feeding experiences may influence later health, we aimed to examine relations between feeding patterns over the first year of life and child's growth in the first 5 years of life.

METHODS

Our analysis included 1022 children from the EDEN mother-child cohort. Three feeding patterns were previously identified, i.e. 'Later dairy products introduction and use of ready-prepared baby foods' (pattern-1), 'Long breastfeeding, later main meal food introduction and use of home-made foods' (pattern-2) and 'Use of ready-prepared adult foods' (pattern-3). Associations between the feeding patterns and growth [weight, height and body mass index {BMI}] were analysed by multivariable linear regressions. Anthropometric changes were assessed by the final value adjusted for the initial value.

RESULTS

Even though infant feeding patterns were not related to anthropometric measurements at 1, 3 and 5 years, high scores on pattern-1 were associated with higher 1-3 years weight and height changes. High scores on pattern-2 were related to lower 0-1 year weight and height changes, higher 1-5 years weight and height changes but not to BMI changes, after controlling for a wide range of potential confounding variables including parental BMI. Scores on pattern-3 were not significantly related to growth. Additional adjustment for breastfeeding duration reduced the strength of the associations between pattern-2 and growth but not those between pattern-1 and height growth.

CONCLUSION

Our findings emphasize the relevance of considering infant feeding patterns including breastfeeding duration, age of complementary foods introduction as well as type of foods used when examining effects of early infant feeding practices on later health. © 2017 World Obesity Federation.

Does the early introduction of solids promote obesity?

Childhood obesity is a major public health challenge across the developed world, and it is vital to understand the modifiable factors that contribute to it. The influence of early-life nutrition on predisposition to later obesity and metabolic disease is now well established. Much research has concentrated on the preventative effects of breastfeeding in relation to childhood obesity risk, but the optimal timing of introducing solid foods has received far less attention. This remains a much-debated and contentious issue, and differing guidelines from international bodies have caused confusion among parents. There is no conclusive evidence from current research that introducing solids before six months of age is associated with an increased risk of obesity in infancy or childhood. Current studies suggest that the most clearly established risk factor for childhood obesity is maternal body mass index. There is a need for continued research in this area.

Characteristics Associated With Adding Cereal Into the Bottle Among Immigrant Mother-Infant Dyads of Low Socioeconomic Status and Hispanic Ethnicity

OBJECTIVE

Determine maternal and infant characteristics associated with adding cereal into the bottle.

DESIGN

Secondary data analysis.

PARTICIPANTS

Study participants were immigrant, low-income, urban mother-infant dyads (n = 216; 91% Hispanic, 19% US-born) enrolled in a randomized controlled trial entitled the Bellevue Project for Early Language, Literacy and Education Success.

MAIN OUTCOME MEASURES

Maternal characteristics (age, marital status, ethnicity, primary language, country of origin, education, work status, income, depressive symptoms, and concern about infant's future weight) and infant characteristics (gender, first born, and difficult temperament).

ANALYSIS

Fisher exact test, chi-square test, and simultaneous multiple logistic regression of significant (P < .05) variables identified in unadjusted analyses.

RESULTS

Twenty-seven percent of mothers added cereal into the bottle. After adjusting for confounding variables identified in bivariate analyses, mothers who were single (P = .02), had moderate to severe depressive symptoms (P = .01) and perceived their infant had a difficult temperament (P = .03) were more likely to add cereal into the bottle. Conversely, mothers who expressed concern about their infants becoming overweight were less likely to add cereal (P = .02).

CONCLUSIONS AND IMPLICATIONS

Health care providers should screen for adding cereal in infant bottles. Further research is needed to investigate the impact of adding cereal into the bottle on weight trajectories over time. Causal associations also need to be identified to effectively prevent this practice.

Maternal breastfeeding, early introduction of non-breast milk, and excess weight in preschoolers

Objective:

Investigate associations between excess weight in preschool children, breastfeeding duration and age of non-breast milk introduction.

Methods:

Cross-sectional study of a representative sample of 817 preschool children, aged 2-4 years, attending municipal day care centers in the city of Taubaté. The weight and height of children were measured in the day care centers in 2009, 2010 and 2011. The body mass index z-score (BMIz) was calculated and children were classified as risk of overweight (BMIz≥1 to<2) or excess weight (BMIz≥2). Data analysis was carried out by comparison of proportions, coefficient of correlation and multivariate linear regression.

Results:

The prevalence of risk of overweight was 18.9% and of excess weight (overweight or obesity) was 9.3%. The median duration of breastfeeding and age of introduction of non-breast milk was 6 months. The child's BMIz showed direct correlation with birth weight (r=0.154; p<0.001) and maternal body mass index (BMI) (r=0.113; p=0.002). The correlation was inverse with the total duration of breastfeeding (r=−0.099; p=0.006) and age at non-breast milk introduction (r=−0.112; p=0.002). There was no correlation between the child's BMIz with birth length, duration of exclusive breastfeeding and mother's age.

Conclusions:

The earlier the introduction of non-breast milk, the higher the correlation with excess weight at preschool age.

The Impact of Timing of Introduction of Solids on Infant Body Mass Index

OBJECTIVES

To evaluate the associations between breastfeeding duration, age at solids introduction, and their interaction in relation to infant (age 9-15 months) above normal body mass index (BMI).

STUDY DESIGN

Cross-sectional, population-based study with 3153 infants from Melbourne (2007-2011). Above normal BMI (z score > 2, equivalent to >97.7th percentile) defined using the World Health Organization standard.

RESULTS

Both longer duration of full and any (full or partial) breastfeeding were associated with lower odds of above normal BMI (eg, aOR, 0.37 [95% CI, 0.22-0.60] for full breastfeeding 4-5 months versus 0-1 months). Compared with introduction of solids at 5-6 months, both early and delayed introduction were associated with increased odds of above normal BMI (aOR for 4 months, 1.75 [95% CI, 1.10-2.80] and for ≥7 months, 2.64 [95% CI, 1.26-5.54] versus 6 months). Such associations differ by breastfeeding status at 4 months (interaction P = .08). Early introduction of solids was associated with increased odds of above normal BMI in both infants fully or partially breastfed for ≥4 months (aOR, 3.66; 95% CI, 1.41-9.51) and those breastfed for <4 months (aOR, 3.11; 95% CI, 1.39-6.97). Introduction of solids at ≥7 months was associated with increased odds of above normal BMI (aOR, 5.79; 95% CI, 1.91-17.49) among infants breastfed for <4 months only.

CONCLUSION

Introduction of solids at 5-6 months, compared with either early or delayed introduction, is associated with decreased odds of above normal BMI at 1 year of age, regardless of infants' breastfeeding status at 4 months. These results may have implications for public health guidelines with regard to recommendations about the optimal timing of the introduction of solid foods in infancy.

Breastfeeding practices, timing of introduction of complementary beverages and foods and weight status in infants and toddlers participants of a WIC clinic in Puerto Rico

BACKGROUND

Breastfeeding is associated with lower rates of obesity; in addition, it is also associated with later introduction of beverages and foods; however, this has not been well studied among Hispanics. The objective was to assess breastfeeding practices and timing of introduction of beverages and solid foods in a sample of Hispanic infants and their association with weight status.

SUBJECT AND METHODS

Cross-sectional study in 296 caregivers of infants and toddlers 0-24 months of age participants of a WIC clinic in Puerto Rico. Participants completed several questionnaires and anthropometrics were taken in infants and toddlers. Statistical analysis included correlations, comparison between groups and logistic regression.

RESULTS

A total of 189 participants older than 6 months completed the study. Most infants were breastfed immediately after birth (63.5 %), at the hospital (80.0 %), and at least once (92.3 %) but only 31 % were exclusively breastfed. Median duration of any breastfeeding was 5.0 months and exclusive breastfeeding was 0 months. Excessive weight was found in 22.8 %. Breastfeeding duration was positively associated with caregiver's educational level and age of introduction of water, formula, juice and cow's milk (p < 0.05). Exclusively breastfed infants were introduced water and formula at a later age compared to non-exclusively breastfed and never breastfed infants (p < 0.01). No significant associations were found between breastfeeding practices and duration or age of introduction of beverages and foods with weight status, even after adjusting for potential confounders.

CONCLUSIONS

Breastfeeding duration was in general low. Water, formula and juice were introduced later in breastfed infants compared to non-exclusively breastfed or never breastfed infants. Breastfeeding practices or timing of introduction of beverages and solid foods were not significantly associated with weight status. Strategies to support mothers on continuing breastfeeding beyond the hospital and for longer periods are needed among WIC participants to benefit of the protective effect on childhood obesity.

Nutrition in the First 1000 Days: The Origin of Childhood Obesity

Childhood obesity is a major global issue. Its incidence is constantly increasing, thereby offering a threatening public health perspective. The risk of developing the numerous chronic diseases associated with this condition from very early in life is significant. Although complex and multi-factorial, the pathophysiology of obesity recognizes essential roles of nutritional and metabolic aspects. Particularly, several risk factors identified as possible determinants of later-life obesity act within the first 1000 days of life (i.e., from conception to age 2 years). The purpose of this manuscript is to review those key mechanisms for which a role in predisposing children to obesity is supported by the most recent literature. Throughout the development of the human feeding environment, three different stages have been identified: (1) the prenatal period; (2) breast vs. formula feeding; and (3) complementary diet. A deep understanding of the specific nutritional challenges presented within each phase might foster the development of future preventive strategies.

Predictors of blood pressure at 7-13 years: The "new millennium baby" study

BACKGROUND AND AIMS

The purpose of this study is to evaluate the association between blood pressure (BP) at 7-13 years of age and body mass index (BMI), early feeding, lifestyle indicators, and parental characteristics.

METHODS AND RESULTS

Retrospective plus cross-sectional cohort study was started in 1294 children born in 2000-2004, right from their birth in primary care settings. Early feeding was estimated by measuring breast-feeding (BF) duration, complementary feeding (CF) introduction time, and lifestyle indicators such as daily screen time and weekly extracurricular sports activity time. Parental education, smoking, and obesity-related diseases were also considered. Multivariable linear regression and mediation analysis were used. CF introduction at 5-6 months of age was a negative predictor of systolic and diastolic BP (mean systolic BP-standard deviation score (SDS) -0.38 [95% CI: -0.47, -0.29] (p < 0.001); mean diastolic BP-SDS -0.32 [95% CI: -0.40, -0.24]) (p < 0.001); BMI was a positive predictor of systolic and diastolic BP (p < 0.001); and parental hypertension was a positive predictor of diastolic BP (p < 0.05). Predictors of mean BMI-SDS at 7-13 years of age were birth weight, screen time, and parental obesity and smoking (p < 0.001). BF had no effect on BP or BMI. Mediation analysis showed virtually no indication of the effect of CF on BP mediated by BMI.

CONCLUSIONS

CF introduction between 5 and 6 months of age could be associated with low BP at 7-13 years. The effect of CF on BP seems to be independent of BMI. Low screen time is associated with low BMI. CF time may play a role in the occurrence of surrogates of noncommunicable disorders in future.

Differences in the anthropometry of Asian children and its role in metabolic health in later life: A narrative review

BACKGROUND

The increasing incidence of childhood obesity in Asia could be a reflection of early life programming in which environmental/nutritional challenges during pregnancy and first two years of life (the so-called first 1000 days) influence later health.

OBJECTIVE OF NARRATIVE REVIEW

To assess differences/similarities of anthropometric measures in early life and their influences on metabolic health risk in later life among children in Asia.

METHODS

Literature search for publication in English using selected key words from Medline (PubMed), Scopus, Science Direct and Google Scholar published from 1994 to October 2014. Some comparisons with Caucasian setting were made when relevant.

RESULTS

From 152 publications selected for this narrative review, differences in foetal growth and birth weight were deducted between Asian and Caucasian children. Infants in India and Hong Kong had increased fat mass at birth and early infancy as compared to those from other parts of the world. Pre- and during pregnancy conditions influenced birth weight; feeding practices and gender influenced post-natal growth and body composition development. High and low birth weights followed by rapid postnatal growth were linked to increased risks of obesity, insulin resistance and high blood pressure in later life.

CONCLUSION

Foetal and postnatal growth trajectories are different between countries within and outside Asia. Extremes in birth weight followed by rapid postnatal growth were linked to increased risks of metabolic health of children in this region. As there is limited evidence in Asia, it is important to conduct thorough investigations by using longitudinal studies on early life programming.

Maternal breastfeeding, early introduction of non-breast milk, and excess weight in preschoolers

OBJECTIVE

Investigate associations between excess weight in preschool children, breastfeeding duration and age of non-breast milk introduction.

METHODS

Cross-sectional study of a representative sample of 817 preschool children, aged 2 to 4 years, attending municipal day care centers in the city of Taubaté. The weight and height of children were measured in the day care centers in 2009, 2010 and 2011. The body mass index z-score (BMIz) was calculated and children were classified as risk of overweight (BMIz≥1 to<2) or excess weight (BMIz≥2). Data analysis was carried out by comparison of proportions, coefficient of correlation and multivariate linear regression.

RESULTS

The prevalence of risk of overweight was 18.9% and of excess weight (overweight or obesity) was 9.3%. The median duration of breastfeeding and age of introduction of non-breast milk was 6 months. The child's BMIz showed direct correlation with birth weight (r=0.154; p<0.001) and maternal Body Mass Index (BMI) (r=0.113; p=0.002). The correlation was inverse with the total duration of breastfeeding (r=-0.099; p=0.006) and age at non-breast milk introduction (r=-0.112; p=0.002). There was no correlation between the child's BMIz with birth length, duration of exclusive breastfeeding and mother's age.

CONCLUSIONS

The earlier the introduction of non-breast milk, the higher the correlation with excess weight at preschool age.

A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment

BACKGROUND

Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment.

METHODS

One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis.

RESULTS

Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours.

CONCLUSIONS

Interventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers' various feeding practices, taking into account motivational and social influences.

Breastfeeding practices on postnatal wards in urban and rural areas of the Deyang region, Sichuan province of China

BACKGROUND

Despite the efforts that have been made to promote breastfeeding in China since the 1990s, there is still a very low prevalence of exclusive breastfeeding. The objective of this study was to assess the current situation of infant feeding practices during the postpartum hospital stay in urban and rural areas of the Deyang region.

METHODS

Cross-sectional sampling was used in two urban hospitals and five rural clinics in the Deyang region of southwestern China. Interviews with mothers after delivery (urban n = 102, rural n = 99) were conducted before discharge and five focus group discussions were held.

RESULTS

The prevalence of Caesarean section was high in both urban and rural areas (63.9 % urban vs. 68.4 % rural). After birth, nearly all mothers (98.0 % urban vs. 99.0 % rural) initiated breastfeeding. One week after delivery, the prevalence of exclusive breastfeeding was 8.0 % (9.8 % urban vs. 6.1 % rural), almost exclusive breastfeeding 34.5 % (29.4 % urban vs. 39.8 % rural), mixed feeding 56.0 % (58.8 % urban vs. 53.1 % rural), and exclusive formula feeding 1.5 % (2.0 % urban vs. 1.0 % rural). Breastfeeding initiation (≤ two days after birth) was positively associated (Odds Ratio [OR] 1.97, 95 % Confidence Interval [CI] 1.11, 3.50) with exclusive and almost exclusive breastfeeding, whereas birth length under 50 cm (OR 0.48, 95 % CI 0.26, 0.87), mother's education > 12 years (OR 0.46, 95 % CI 0.24, 0.88) and mother's lack of knowledge about the importance of colostrum (OR 0.35, 95 % CI 0.14, 0.86) were negatively associated with almost exclusive breastfeeding.

CONCLUSION

Although disparities between urban and rural areas exist, the situation of infant feeding is inadequate in both settings. The high prevalence of Caesarean section, the mothers' poor knowledge of the physiology of breast milk production, the mothers' lack of breastfeeding confidence, the widespread advertising of breast milk substitutes, and the changing perception of the function of breasts, may influence the unfavorable breastfeeding behavior observed in the study area.